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Guides through treatment choices for stage I nonseminoma testicular cancer after surgery to remove the testicle. Lists reasons for and against surveillance, chemotherapy, and lymph node surgery. Includes interactive tool to help you decide.

Guides through treatment choices for stage I nonseminoma testicular cancer after surgery to remove the testicle. Lists reasons for and against surveillance, chemotherapy, and lymph node surgery. Includes interactive tool to help you decide.

Testicular Cancer: Which Treatment Should I Have for Stage I Nonseminoma Testicular Cancer After My Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Testicular Cancer: Which Treatment Should I Have for Stage I Nonseminoma Testicular Cancer After My Surgery?

Your options

For most men faced with testicular
cancer, surgery to remove the testicle is the first treatment. After surgery, you and your doctor must decide what to do next. For stage I
nonseminoma testicular cancer, these are your choices:

Have
surveillance. This means following a schedule of
regular checkups and tests.

Key points to remember

Testicular cancer is highly curable. Even when the cancer comes back (recurs), it can almost always be treated successfully.

Stage I nonseminoma cancer is either high-risk or low-risk. Tests done 6 to 8 weeks after surgery to remove the testicle will show what your risk is.

For low-risk cancer, most experts agree that surveillance is the preferred option. For high-risk cancer, experts disagree. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.

Lymph node surgery and chemotherapy have some serious risks and side effects. Choosing surveillance lets you avoid these
risks and side effects. Or it will let you put them off for a while. But if you choose surveillance and the cancer comes back, you will need a higher dose of chemotherapy to treat it. A higher dose has more risk for serious side effects.

About 70 out of 100 men who choose surveillance after surgery have been cured by the surgery and don't need more treatment. This means that about 30
of those 100 men do need treatment later.1 But the chances of your cancer coming back will depend on whether it is low-risk or high-risk.

For surveillance, you must be willing to have frequent
checkups and tests. Without this close follow-up, if the cancer comes back, it
might not be found until it has spread and is harder to treat.

There are two main types of testicular cancer: seminoma and nonseminoma. Nonseminomas often grow and spread more quickly than seminomas. Nonseminomas also are more likely to
spread to the lungs, liver, and brain.

"Stage I" means that the
cancer is only in the testicle and hasn't spread beyond it.

Both seminoma and nonseminoma are very often cured, especially if
they are found and treated early. Compared to other forms of cancer, testicular
cancer—even when it has spread to other parts of the body—has a very high cure
rate.

The first treatment is surgery to remove the testicle. After 6 to 8 weeks, tests will be done to find out if your cancer is low-risk or high-risk. Some men who choose surveillance will need more treatment. But any of the three choices will cure the cancer in about 99 out of 100 men with nonseminoma cancer.1

For men with low-risk (stage IA) nonseminoma, cancer comes back in about 20 to 30 out of 100 men.2 Most experts agree that surveillance is the preferred option for low-risk nonseminoma.

For men with high-risk (stage IB) nonseminoma, cancer comes back in about 50 out of 100 men.2 Experts disagree on the best treatment for high-risk nonseminoma. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.

Surveillance

Surveillance means that you are
being watched closely by your doctor but are not having further
treatment.

You have exams, chest X-rays, and blood tests regularly
during the first few years, as well as
CT scans. It can be hard to go to the doctor's office
that often. Unless your cancer comes back, the number of checkups and tests
will gradually decrease over the next 10 years.

With surveillance, you may be able to avoid the risks and
side effects of lymph node surgery or chemotherapy.

Even when cancer is
found after a period of surveillance, it is almost always possible to cure if it's
found early. Because of this, most experts consider surveillance the preferred option for men
with low-risk cancer.

Chemotherapy

Chemotherapy,
often called "chemo," is the use of very strong drugs to kill cancer cells.

A short course of chemo has been designed for stage I nonseminoma cancer, especially for men who have high-risk cancer. Several medicines are used.

Lymph node surgery

The full name for this surgery is
retroperitoneal lymph node dissection (or RPLND). It is surgery to
remove lymph nodes in the lower back and pelvis. These lymph nodes may contain
cancer.

During the early phases of the
cancer, it can be very hard to tell if these lymph nodes have cancer without
taking them out. In the past, doing this often caused infertility. Modern
nerve-sparing methods have greatly lowered the chances
of infertility.

Having this surgery isn't routine treatment for stage I nonseminoma. But if you and your doctor decide that this treatment is the best option for you, think about having it done at a hospital where many of these surgeries are done.

Perhaps
the greatest risk of choosing surveillance is missing your
follow-up tests and exams. Without regular testing and checkups, you can miss
cancer that has returned until it spreads beyond the lymph nodes and is harder
to cure. If you choose surveillance, it's very important to strictly follow
your doctor's schedule of tests and exams.

When cancer does come
back during surveillance, it usually hasn't spread any farther than the
lymph nodes in the lower back and pelvis. It can usually be treated
successfully when the testing schedule has been followed closely.

Other risks include radiation exposure from CT scans, which need to be done for surveillance. Also, if your cancer does come back, you will need to have a higher dose of chemotherapy than if you'd had it soon after your surgery.

Chemotherapy for testicular cancer has caused
permanent infertility in some men. Because most men diagnosed with this cancer
are younger than 35, this is important to think about when you choose which
treatment to use.

Some men still need surgery after chemo to
remove damaged tissue or remaining cancer. In those cases it is not always
possible for the surgeon to use nerve-sparing methods that greatly reduce the
chances of infertility.

Men who are going to have chemo should bank
their sperm ahead of time if they want to father children in the future. Talk
to your doctor about any fertility concerns you may have.

Side effects of chemo

Common short-term side effects include:

Nausea and vomiting.

Hair
thinning or hair loss.

Mouth
sores.

Diarrhea.

A higher chance of bleeding and
infection.

The chemo used for testicular cancer has also been linked
with serious long-term side effects. These side
effects may include:

The
risks and side effects of lymph node surgery for testicular cancer
include:

Chylous ascites. With this condition, fluids collect
inside the belly. This may cause belly pain and make it hard to breathe.

Lymphedema. This is a collection of fluid that causes
swelling in the arms, legs, and genitals.

Bleeding.

Pulmonary embolism. This is a sudden blockage of blood
flow in the lung.

Fertility problems after surgery

Men who get lymph node surgery can end up with
nerve damage that causes retrograde ejaculation. This means that the semen
flows up into the bladder instead of out through the penis. This makes you
unable to father children.

In most cases, men with retrograde
ejaculation don't have erection problems or trouble enjoying sex.

Nerve-sparing methods have
greatly lowered the risk of retrograde ejaculation. Nerve-sparing
surgery may be more difficult or impossible for men who have had chemotherapy.
Talk to your doctor about whether nerve-sparing surgery is an option for
you.

General surgery risks

Like any major surgery, the risks include:

Pain after surgery. Your doctor may give you a prescription for pain medicine or have you
try
over-the-counter pain medicine.

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

After I got over the shock of my
diagnosis, we talked about my treatment choices. My doctor told me that because
we caught the cancer at an early stage, I had to decide on which treatment
option was best for me. After discussing it with my wife, we decided on the
RPLND. We also felt the stress of surveillance would be just too much for
us, especially since we have a young child and would like to have another.
My doctor says that I'm still cancer-free after 2 years, but the surgery did
cause me to become infertile. Although I did bank sperm before the surgery,
part of me wishes I had given more thought to surveillance.

Lorenzo, age
37

When my doctor told me I had testicular
cancer, I was devastated. I decided that I would do everything in my power to
beat this disease. After discussing it with my doctor I decided to go ahead
with chemotherapy. I knew there was a chance that I didn't need it, but I
wanted to get it over with as soon as possible so I could continue with my
life. Because my cancer was early-stage, the chemotherapy program wasn't very
intensive. And the side effects were barely noticeable. That was a year ago, and
I feel great. I know I made the right decision for me.

Michael, age 31

At first I
couldn't believe what the doctor was telling me. How could I have cancer? I
thought I was too young for something like that. After going through a period
of denial and anger, I decided I was going to do whatever I could to beat it.
My doctor said I was fortunate because we had caught it at an early stage.
After orchiectomy, I was told I could either go for surgery to remove lymph
nodes in my pelvis, have chemotherapy, or try surveillance. I decided to
wait and see if my cancer was gone before having other treatment. I'm young and
don't like the idea of having major surgery or chemotherapy if I don't have to,
especially since they can cause other problems later on. The follow-up schedule
has been hard to stick to at times. But it's been over a year, and the doctor
says I'm still cancer-free, so I think it's been worth it.

Sam, age 20

After being
diagnosed with a stage I nonseminoma, I decided to try a surveillance
program after my orchiectomy. I made all of my follow-up appointments and felt
confident that my cancer was gone for good. Well, about 8 months after I
started the program, we found out that my cancer had spread to the lymph nodes
in my pelvis. Now my doctor tells me that I'm going to need chemotherapy to cure my cancer. I can't believe that the cancer came back. But my doctor says that my chances are really good that I will be cured. I hope he is right.

David, age 33

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I want chemo or lymph node surgery for the best chance of cure at the start.

Not important

Somewhat important

Very important

I might not need more treatment, so I want surveillance.

Not important

Somewhat important

Very important

I'd rather have side effects from treatment than have surveillance.

Not important

Somewhat important

Very important

I can make sure I go to checkups and tests during surveillance.

Not important

Somewhat important

Very important

I don't mind banking my sperm to have treatment.

Not important

Somewhat important

Very important

My other important reasons:

Not important

Somewhat important

Very important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surveillance

NOT using surveillance

Leaning toward

Undecided

Leaning toward

Chemotherapy

NOT having chemotherapy

Leaning toward

Undecided

Leaning toward

Surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does surveillance simply mean having a special test during your yearly checkup?

YesSorry, that's wrong. If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.

NoYou're right. If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.

I'm not sureIt may help to go back and read "Get the Facts." If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.

2.

Are lymph node surgery and chemotherapy the
surest ways to keep cancer from coming back?

YesThat's right. They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.

NoSorry, that's not right. They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.

I'm not sure.It may help to go back and read "Get the Facts." They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.

3.

If you're worried that chemotherapy or surgery will leave you infertile, can you bank your sperm ahead of time?

YesThat's right. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.

NoSorry, that's wrong. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.

I'm not sureIt may help to go back and read "Get the Facts." If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Testicular Cancer: Which Treatment Should I Have for Stage I Nonseminoma Testicular Cancer After My Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

For most men faced with testicular
cancer, surgery to remove the testicle is the first treatment. After surgery, you and your doctor must decide what to do next. For stage I
nonseminoma testicular cancer, these are your choices:

Have
surveillance. This means following a schedule of
regular checkups and tests.

Key points to remember

Testicular cancer is highly curable. Even when the cancer comes back (recurs), it can almost always be treated successfully.

Stage I nonseminoma cancer is either high-risk or low-risk. Tests done 6 to 8 weeks after surgery to remove the testicle will show what your risk is.

For low-risk cancer, most experts agree that surveillance is the preferred option. For high-risk cancer, experts disagree. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.

Lymph node surgery and chemotherapy have some serious risks and side effects. Choosing surveillance lets you avoid these
risks and side effects. Or it will let you put them off for a while. But if you choose surveillance and the cancer comes back, you will need a higher dose of chemotherapy to treat it. A higher dose has more risk for serious side effects.

About 70 out of 100 men who choose surveillance after surgery have been cured by the surgery and don't need more treatment. This means that about 30
of those 100 men do need treatment later.1 But the chances of your cancer coming back will depend on whether it is low-risk or high-risk.

For surveillance, you must be willing to have frequent
checkups and tests. Without this close follow-up, if the cancer comes back, it
might not be found until it has spread and is harder to treat.

What is stage I nonseminoma testicular cancer?

There are two main types of testicular cancer: seminoma and nonseminoma. Nonseminomas often grow and spread more quickly than seminomas. Nonseminomas also are more likely to
spread to the lungs, liver, and brain.

"Stage I" means that the
cancer is only in the testicle and hasn't spread beyond it.

Both seminoma and nonseminoma are very often cured, especially if
they are found and treated early. Compared to other forms of cancer, testicular
cancer—even when it has spread to other parts of the body—has a very high cure
rate.

What are the treatment choices for stage I nonseminoma testicular cancer?

The first treatment is surgery to remove the testicle. After 6 to 8 weeks, tests will be done to find out if your cancer is low-risk or high-risk. Some men who choose surveillance will need more treatment. But any of the three choices will cure the cancer in about 99 out of 100 men with nonseminoma cancer.1

For men with low-risk (stage IA) nonseminoma, cancer comes back in about 20 to 30 out of 100 men.2 Most experts agree that surveillance is the preferred option for low-risk nonseminoma.

For men with high-risk (stage IB) nonseminoma, cancer comes back in about 50 out of 100 men.2 Experts disagree on the best treatment for high-risk nonseminoma. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.

Surveillance

Surveillance means that you are
being watched closely by your doctor but are not having further
treatment.

You have exams, chest X-rays, and blood tests regularly
during the first few years, as well as
CT scans. It can be hard to go to the doctor's office
that often. Unless your cancer comes back, the number of checkups and tests
will gradually decrease over the next 10 years.

With surveillance, you may be able to avoid the risks and
side effects of lymph node surgery or chemotherapy.

Even when cancer is
found after a period of surveillance, it is almost always possible to cure if it's
found early. Because of this, most experts consider surveillance the preferred option for men
with low-risk cancer.

Chemotherapy

Chemotherapy,
often called "chemo," is the use of very strong drugs to kill cancer cells.

A short course of chemo has been designed for stage I nonseminoma cancer, especially for men who have high-risk cancer. Several medicines are used.

Lymph node surgery

The full name for this surgery is
retroperitoneal lymph node dissection (or RPLND). It is surgery to
remove lymph nodes in the lower back and pelvis. These lymph nodes may contain
cancer.

During the early phases of the
cancer, it can be very hard to tell if these lymph nodes have cancer without
taking them out. In the past, doing this often caused infertility. Modern
nerve-sparing methods have greatly lowered the chances
of infertility.

Having this surgery isn't routine treatment for stage I nonseminoma. But if you and your doctor decide that this treatment is the best option for you, think about having it done at a hospital where many of these surgeries are done.

What are the risks of surveillance?

Perhaps
the greatest risk of choosing surveillance is missing your
follow-up tests and exams. Without regular testing and checkups, you can miss
cancer that has returned until it spreads beyond the lymph nodes and is harder
to cure. If you choose surveillance, it's very important to strictly follow
your doctor's schedule of tests and exams.

When cancer does come
back during surveillance, it usually hasn't spread any farther than the
lymph nodes in the lower back and pelvis. It can usually be treated
successfully when the testing schedule has been followed closely.

Other risks include radiation exposure from CT scans, which need to be done for surveillance. Also, if your cancer does come back, you will need to have a higher dose of chemotherapy than if you'd had it soon after your surgery.

What are the risks of chemotherapy?

Chemotherapy for testicular cancer has caused
permanent infertility in some men. Because most men diagnosed with this cancer
are younger than 35, this is important to think about when you choose which
treatment to use.

Some men still need surgery after chemo to
remove damaged tissue or remaining cancer. In those cases it is not always
possible for the surgeon to use nerve-sparing methods that greatly reduce the
chances of infertility.

Men who are going to have chemo should bank
their sperm ahead of time if they want to father children in the future. Talk
to your doctor about any fertility concerns you may have.

Side effects of chemo

Common short-term side effects include:

Nausea and vomiting.

Hair
thinning or hair loss.

Mouth
sores.

Diarrhea.

A higher chance of bleeding and
infection.

The chemo used for testicular cancer has also been linked
with serious long-term side effects. These side
effects may include:

What are the risks of lymph node surgery?

The
risks and side effects of lymph node surgery for testicular cancer
include:

Chylous ascites. With this condition, fluids collect
inside the belly. This may cause belly pain and make it hard to breathe.

Lymphedema. This is a collection of fluid that causes
swelling in the arms, legs, and genitals.

Bleeding.

Pulmonary embolism. This is a sudden blockage of blood
flow in the lung.

Fertility problems after surgery

Men who get lymph node surgery can end up with
nerve damage that causes retrograde ejaculation. This means that the semen
flows up into the bladder instead of out through the penis. This makes you
unable to father children.

In most cases, men with retrograde
ejaculation don't have erection problems or trouble enjoying sex.

Nerve-sparing methods have
greatly lowered the risk of retrograde ejaculation. Nerve-sparing
surgery may be more difficult or impossible for men who have had chemotherapy.
Talk to your doctor about whether nerve-sparing surgery is an option for
you.

General surgery risks

Like any major surgery, the risks include:

Pain after surgery. Your doctor may give you a prescription for pain medicine or have you
try
over-the-counter pain medicine.

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"After I got over the shock of my diagnosis, we talked about my treatment choices. My doctor told me that because we caught the cancer at an early stage, I had to decide on which treatment option was best for me. After discussing it with my wife, we decided on the RPLND. We also felt the stress of surveillance would be just too much for us, especially since we have a young child and would like to have another. My doctor says that I'm still cancer-free after 2 years, but the surgery did cause me to become infertile. Although I did bank sperm before the surgery, part of me wishes I had given more thought to surveillance."

— Lorenzo, age
37

"When my doctor told me I had testicular cancer, I was devastated. I decided that I would do everything in my power to beat this disease. After discussing it with my doctor I decided to go ahead with chemotherapy. I knew there was a chance that I didn't need it, but I wanted to get it over with as soon as possible so I could continue with my life. Because my cancer was early-stage, the chemotherapy program wasn't very intensive. And the side effects were barely noticeable. That was a year ago, and I feel great. I know I made the right decision for me."

— Michael, age 31

"At first I couldn't believe what the doctor was telling me. How could I have cancer? I thought I was too young for something like that. After going through a period of denial and anger, I decided I was going to do whatever I could to beat it. My doctor said I was fortunate because we had caught it at an early stage. After orchiectomy, I was told I could either go for surgery to remove lymph nodes in my pelvis, have chemotherapy, or try surveillance. I decided to wait and see if my cancer was gone before having other treatment. I'm young and don't like the idea of having major surgery or chemotherapy if I don't have to, especially since they can cause other problems later on. The follow-up schedule has been hard to stick to at times. But it's been over a year, and the doctor says I'm still cancer-free, so I think it's been worth it."

— Sam, age 20

"After being diagnosed with a stage I nonseminoma, I decided to try a surveillance program after my orchiectomy. I made all of my follow-up appointments and felt confident that my cancer was gone for good. Well, about 8 months after I started the program, we found out that my cancer had spread to the lymph nodes in my pelvis. Now my doctor tells me that I'm going to need chemotherapy to cure my cancer. I can't believe that the cancer came back. But my doctor says that my chances are really good that I will be cured. I hope he is right."

— David, age 33

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I want chemo or lymph node surgery for the best chance of cure at the start.

Not important

Somewhat important

Very important

I might not need more treatment, so I want surveillance.

Not important

Somewhat important

Very important

I'd rather have side effects from treatment than have surveillance.

Not important

Somewhat important

Very important

I can make sure I go to checkups and tests during surveillance.

Not important

Somewhat important

Very important

I don't mind banking my sperm to have treatment.

Not important

Somewhat important

Very important

My other important reasons:

Not important

Somewhat important

Very important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surveillance

NOT using surveillance

Leaning toward

Undecided

Leaning toward

Chemotherapy

NOT having chemotherapy

Leaning toward

Undecided

Leaning toward

Surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Does surveillance simply mean having a special test during your yearly checkup?

Yes

No

I'm not sure

You're right. If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.

2.
Are lymph node surgery and chemotherapy the
surest ways to keep cancer from coming back?

Yes

No

I'm not sure.

That's right. They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.

3.
If you're worried that chemotherapy or surgery will leave you infertile, can you bank your sperm ahead of time?

Yes

No

I'm not sure

That's right. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

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